Insurance Denials Terms to Know in Wilmington
Dealing with an insurance claim of any kind is a difficult task to take on by yourself. However, there are several insurance denials terms to know in Wilmington that could help you better understand the insurance denial process and what you could do to turn the situation into your favor.
Though it is a benefit to becoming familiar with these terms, it is still strongly recommended to work with an experienced attorney when dealing with insurance companies. Call today to learn more.
How Does the Insurance Industry Define a Class Rating in Wilmington?
A class rating, or insurance risk class, is a group of individuals or companies that have similar characteristics that are used to determine the risk associated with underwriting a new policy and the premium that that company would charge them for that coverage.
For example, if a person is living in Wilmington, they are in a risk class of individuals with a similar characteristic of living on the coast. Their home is much more likely to sustain damage from a hurricane when they are living in Wilmington, New Bern, Beaufort, Jacksonville, Atlantic Beach, or Ocracoke and areas in the barrier islands and extending to the outer banks.
What is an Insurance Claim Denial?
An insurance claim denial occurs when a person files for damage to their home and the insurance company tells them that that damage is not covered under their policy. The insurance company is responsible for conducting a thorough investigation, which might involve hiring an engineer. Insurance companies at the very least should hire a field adjuster to assess the damage stated in the claim. If at the conclusion the investigation it is believed that the damage is not covered, they would then deny the person’s claim. Unfortunately, they often will not do a reasonable investigation and deny the claim without conducting a reasonable investigation, which is illegal in North Carolina under their insurance laws.
What is an Appeal?
An appeal in the homeowner’s insurance context can take on several different definitions. It depends on what their homeowner’s insurance policy says because their homeowner’s insurance policy is a contract between them, the insured, and the insurance company. It also depends on the rights that are given to them in that contract as to what they can appeal to.
Usually, the contract will allow for them to make a written appeal to their insurance company if they are to deny their claim or if they are to underpay their claim. If they claim there is $50,000 worth of damage to the home and they only pay them $25,000, they can file an appeal.
What is a Claims Adjuster?
A claims adjuster’s job is to look at the claim that a homeowner is making about damage to their home, and to determine the value of that claim. Usually, there are two types of claims adjusters: an independent claims adjuster and one that works for the insurance company. In most cases, adjusters will. Adjusters are responsible for adjusting the amount of damage that the insurance company is going to pay. That term implies that their job is often to adjust that amount as low as possible in order to save money for the insurance company if that is who they are working for. A public adjuster in this scenario would not focus on saving the insurance company money. Instead, they will try to conduct a thorough and fair investigation that would evaluate a person’s losses and place a numerical value on it.
Why is it Important to Contact an Attorney?
Our law firm has public adjusters who are independent claims adjusters instead of those that work for the insurance company. These are independent people who will go look at the damage to their home and they will provide an independent value as to the loss rather than a value that the insurance company has come up with.
As anyone can probably imagine, that number is going to be more favorable for the homeowner because it is independent and separate from the insurance company.
